Clinical, Cosmetic and Investigational Dermatology最新文献

Background: Although dedicated dermatology wards have been closed in some countries, they continue to exist in others. Inpatient consultations requested from dermatologists have been investigated widely. However, those requested by dermatologists have been taken into consideration only in a few studies.

Objective: This study aimed to investigate such consultations, particularly in the context of diagnoses, reasons, and consulting specialties.

Methods: Patients admitted to the dermatology ward of a tertiary hospital in Turkey between January 2019 and August 2021 were retrospectively analyzed.

Results: The most common diagnoses were non-pustular psoriasis (11.5%), pruritus (10.9%), and urticaria (10.6%) in 548 admissions with a median length of stay of 15.1 days. There were 1712 consultations. Their number per admission was positively correlated with patient's age and length of stay. Highest numbers were observed in admissions with a diagnosis of bullous pemphigoid, leg ulcers, lupus erythematosus, pustular psoriasis, hidradenitis suppurativa, and pemphigus. Reasons for consultation were management of comorbidity (53.8%), evaluation for drug precaution (19.1%), investigation for etiology (12.8%), evaluation for systemic involvement (6.0%), taking treatment advice (5.4%), obtaining biopsy (3.0%), and differential diagnosis (1.9%).

Conclusion: Our findings showed that the number of consultations per admission was high, and the most common reason for consultation was comorbidity, indicating that, practically, there are no more pure dermatological patients. Therefore, if dedicated dermatology wards will continue to exist, in order to lower the number of consultations so length of stay, dermatologist should be trained in a manner so that they have more knowledge about common comorbidities.

Hypergammaglobulinemia is a sign of B cell and plasma cell hyperactivity marked by elevated levels of gamma globulins, proteins within the gamma fraction of serum electrophoresis, linked to diseases like acute hepatitis, Hodgkin's lymphoma, autoimmune conditions, and neoplasms. Monoclonal gammopathy of undetermined significance (MGUS) is found in 3.2% of individuals over 50 and 5.3% over 70 due to immunosenescence, the gradual immune decline influenced by chronic infections, malnutrition, hormonal dysregulation, and smoking. This retrospective, single-center observational study explored the association between hypergammaglobulinemia and Hidradenitis Suppurativa (HS) based on sex, age, disease severity (IHS4 score), and Adalimumab treatment. Sixty patients (54% women, 46% men, average age 47) were observed over 12 months. Hypergammaglobulinemia was found in 68% of patients, with the highest prevalence in the 15-29 age group (80%). It was also associated with increased disease severity, particularly in younger patients, who showed a reduced clinical response to Adalimumab (average HiSCR difference of 25%). While common inflammation markers like CRP and ESR remain essential for HS management, this study highlighted that hypergammaglobulinemia is more prevalent in younger patients with severe forms of HS. Unlike older patients, where immunosenescence can lead to more normal gamma globulin levels, younger patients demonstrated a strong link between chronic inflammation and disease. The findings suggest further investigation is needed to determine whether hypergammaglobulinemia is merely a marker or contributes to HS pathogenesis. If validated, hypergammaglobulinemia could be used to monitor disease progression and customize treatments. In conclusion, integrating immunological assessments into HS management could improve patient outcomes, particularly in younger demographics. With larger studies, hypergammaglobulinemia might be considered a predictive factor for HS, especially for severe or treatment-resistant cases.

Papular acantholytic dyskeratosis (PAD) of the vulva is an uncommon benign condition characterized by multiple hyperkeratotic papules in the anogenital region. First described in 1984, PAD belongs to the spectrum of focal acantholytic dyskeratoses and shares histopathological features with Darier disease and Hailey-Hailey disease. Despite its persistence, PAD is benign, requiring only reassurance in many cases. However, various treatment modalities have been reported for symptomatic patients, including topical and systemic therapies, and procedural interventions. We present a case of a 21-year-old Thai woman with asymptomatic perivulvar papules with typical histopathological features of PAD. After conservative management, the patient remained asymptomatic during follow-up. Additionally, we present a review of the current literature on this uncommon entity. This case highlights the importance of clinicopathological correlation in diagnosing PAD and distinguishing it from other clinically similar disorders. We discuss the clinical presentation, histopathological features, differential diagnosis, potential genetic associations, and management options for PAD.

Purpose: Psoriasis is associated with obesity, which in turn is linked to increased mortality risk. Therefore, we undertook a cohort study utilizing data from the National Health and Nutrition Examination Survey (NHANES) to examine the impact of weight-adjusted waist index (WWI) on the likelihood of all-cause mortality in psoriasis individuals.

Patients and methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) to investigate the influence of WWI on the probability of all-cause mortality in psoriasis individuals. A retrospective cohort analysis included 19,919 participants aged 18 to 80 years, with or without psoriasis. The primary endpoint studied was all-encompassing mortality up to December 2019. The interplay between WWI and psoriasis was analyzed through multivariable logistic regression techniques. Survival probabilities were assessed employing Kaplan-Meier curves and Cox regression analyses.

Results: Out of the 19,919 subjects that we eventually included, 522 had psoriasis. Psoriasis and WWI were found to be significantly positively correlated. A significant correlation was found between an incremental unit increase in WWI and a 63% increased risk of all-cause mortality risk in psoriasis patients (HR = 1.63, 95% CI 1.02-2.61). Subgroup analyses demonstrated consistent findings within the psoriasis population. These findings suggest an independent impact of WWI on psoriasis risk and mortality.

Conclusion: Our investigation revealed that there is a strong positive correlation between WWI and all-cause mortality in US psoriasis adults. For those with psoriasis, managing WWI, or obesity, is crucial.

Fractional radiofrequency microneedling (FRM) is a popular, minimally invasive skin rejuvenation modality for treating acne scarring. In this study, we aimed to systematically evaluate the current literature on the efficacy and safety of FRM as a monotherapy to treat different types of facial acne scarring. We systematically reviewed all available literature on FRM techniques used for acne scarring by searching the PubMed and EBSCO databases up to July 2024. 16 studies involving 481 patients, comprising six prospective studies, six randomized clinical trials, three retrospective studies, and one comparative trial, were included. FRM is likely an effective treatment for acne scarring when used as a monotherapy. Further randomized controlled trials are needed to establish appropriate treatment parameters.

Background: Recent evidence suggests a crucial biological role for Circular RNAs (circRNAs) in keloid diseases, yet the underlying mechanisms remain unclear. This study explored the biological effects and molecular mechanisms of hsa_circ_0002198 in keloid formation.

Methods: Real-time quantitative PCR (qRT-PCR) was employed to assess the expression of circ_0002198 in keloid tissues, normal skin tissues, keloid fibroblasts (KFs), and normal skin fibroblasts (NFs) from nine patients. To investigate the role of circ_0002198 in keloid pathogenesis, cell transfection technology was utilized to knock down circ_0002198. Various experiments including Cell Counting Kit-8 (CCK-8), 5-Ethynyl-2'-deoxyuridine (EdU), Transwell, wound healing assay, flow cytometry, and others were conducted to explore the potential mechanisms associated with circ_0002198 expression. The RNA-binding protein Eukaryotic translation initiation factor 4A, isoform 3 (EIF4A3) binding to circ_0002198 was identified and confirmed through bioinformatics databases prediction and RNA immunoprecipitation (RIP) assay. Finally, the expression of EIF4A3 was assessed, and both silencing and overexpression were employed to verify its role in circ_0002198 regulation.

Results: The expression levels of circ_0002198 and EIF4A3 were notably elevated in keloid tissues and KFs compared to normal skin tissues and NFs. The reduction of circ_0002198 expression in KFs significantly impeded their proliferation, migration, and invasion. It also hindered the cell cycle process and the expression of associated proteins while concurrently promoting apoptosis in KFs. EIF4A3 was identified to bind to the flanks of circ_0002198, enhancing the occurrence of circ_0002198 and its role in regulating the progression of KFs.

Conclusion: Our study offers insights into how Circular RNA may contribute to the pathogenesis of keloid formation, highlighting Circ_0002198 as a potential novel biomarker for keloids in association with EIF4A3. Further research, involving larger study cohorts, is necessary to broaden our understanding of keloid mechanisms and potential treatment approaches.

Objective: Freckles are common hyperpigmented diseases that commonly occur in Caucasians and Asians. Freckles often cause cosmetic and even psychosocial concerns. Various lasers with different wavelengths have been used to treat pigmented spots. This study aims to evaluate the efficacy and safety of a novel 730-nm Ti: Sapphire picosecond laser in the treatment of freckles in Chinese patients.

Methods: A total of 12 patients with freckles were enrolled. Patients underwent one laser treatment and were followed-up after eight weeks. Images were captured before treatment and at the eight-week follow-up, which were independently examined by two physicians to assess the treatment efficacy, including the lesion clearance rate and global aesthetic improvement scale. Patients recorded their pain and other adverse effects. Ex vivo human foreskins were treated with 730 nm picosecond lasers for one pass with a 3.75 J/cm² and then stained with hematoxylin and eosin (H&E).

Results: The average clearance rate as 74.46% and the mean GAIS as 4.13 ± 0.61. The pain scores were averaged at 3.08 ± 0.79. One patient exhibited hyperpigmentation (8.33%) and another patient developed hypopigmentation (8.33%) by the 8-week follow-up visit. A large number of uniform vacuoles were observed in the epidermal basal layer and the dermal papillae in the ex vivo foreskins, immediately after the treatment with 730-nm Ti: Sapphire picosecond laser. The vacuoles were uniformly sized, principally with 20-40 µm diameter.

Conclusion: The 730-nm Ti: Sapphire picosecond laser is safe and effective for treating freckles.

Nickel stands as one of the prevalent contact allergens, but acquired nail hypertrophy presenting as ACD due to nickel exposure is infrequent. Here we report a case of acquired nail hypertrophy stemming from ACD due to nickel, displaying an uneven coloration, along with nail grooves, deck distortion damage, small surface pits and ecchymosis beneath the damaged deck. The patient limited nickel contact and recovered after 11 months of follow-up.

Purpose: Abnormal melanin synthesis causes hyperpigmentation disorders like melasma and lentigines, impacting psychological well-being. RNA interference (RNAi) uses small RNA molecules to inhibit gene expression by targeting specific mRNA, silencing genes involved in undesirable cellular functions. This study assessed INTASYL compounds, self-delivering RNAi molecules, designed to target and reduce tyrosinase gene expression to decrease pigmentation.

Methods: 36 INTASYL compounds were designed to target and reduce TYR gene expression and tested in a screening assay. RXI-231, the lead compound, was tested in normal human epithelial melanocytes and the MelanoDerm™ model, a 3D reconstituted human epidermal culture. RXI-231 was evaluated for its ability to reduce tyrosinase mRNA expression, in vitro dopachrome formation, and melanin content. Penetration of fluorescently labeled INTASYL compounds through the stratum corneum into the epidermis was tested in cultured porcine skin explants using a DermaPen^® microneedle device and a proprietary mixture of penetration enhancers. RXI-231 was also tested for skin irritation in the MatTek EpiDerm™ model to determine its non-irritant profile.

Results: RXI-231 significantly reduced tyrosinase mRNA expression, dopachrome formation, and melanin content in both normal human melanocytes and the MelanoDerm model. Application of INTASYL compounds every other day visibly reduced pigmentation in the 3D epidermal cultures. Penetration studies showed efficient delivery into the epidermis, overcoming the stratum corneum barrier. RXI-231 showed no irritation, with viability above 50% in the MatTek EpiDerm model, confirming its non-irritant profile.

Conclusion: RXI-231 effectively reduced tyrosinase activity and melanin synthesis, showing promise for treating hyperpigmentation disorders. Further characterization and planned human patient testing are necessary to confirm its clinical potential patient.

Background: The onset of atopic dermatitis (AD) is complex, and its specific pathological mechanisms have not yet been fully elucidated.

Methods: Using circulating multi-omics as the exposure factors and AD as the outcome, we conducted univariable MR analysis. The circulating multi-omics data included immunomics (731 immune cell types), proteomics (4907 plasma proteins), metabolomics (1400 metabolites and 486 additional metabolites), and 91 inflammatory factors. MR analysis was conducted using IVW, WM, Simple Mode, Weighted Mode, and MR-Egger methods, with IVW as the primary analysis tool. To address horizontal pleiotropy, we utilized MR-Egger intercept tests and MR-PRESSO for correction, alongside the Cochrane Q statistic for heterogeneity assessment. Sensitivity analysis was performed using a leave-one-out strategy. To control for false positives due to multiple testing, we set a standard of a 5% false discovery rate. Additionally, we conducted F-statistics on the included SNPs to eliminate the impact of weak instrumental variables.

Results: IL-18R1 on AD (OR = 1.12, 95% CI: 1.08-1.17, P _FDR < 0.01). Mannonate levels on AD (OR = 0.88, 95% CI: 0.83-0.94, P _FDR = 0.03). Retinol (Vitamin A) to linoleoyl-arachidonoyl-glycerol (18:2 to 20:4) on AD (OR = 1.12, 95% CI: 1.06-1.18, PFDR = 0.03). HVEM on CM CD4+ cells on AD (OR = 0.81, 95% CI: 0.75-0.88, P _FDR < 0.01). CR2 on AD (OR = 0.81, 95% CI: 0.72-0.90, P _FDR = 0.04). MANSC1 on AD (OR = 0.87, 95% CI: 0.81-0.93, P _FDR = 0.04). IL18R1 (4097 inflammatory markers) on AD (OR = 1.11, 95% CI: 1.06-1.17, P _FDR = 0.01). HNRNPAB on AD (OR = 1.44, 95% CI: 1.23-1.70, P _FDR < 0.01).

Conclusion: This study further explored the correlations between multi-omics data and AD. We identified seven previously unreported circulating substances with causal relationships to AD, filling a current theoretical gap.